Fish anaphylaxis in Diverse populations

Anaphylaxis to fish is a major public health concern, with disparities in incidence, prevalence, and severity across demographic groups remaining unclear. This study evaluates temporal trends in incidence proportion, prevalence, and incidence rate of fish-related anaphylaxis in a cohort of 114,698,348 patients, comparing 2015–2020 with 2021–2025, stratified by age, sex, and race, and forecasts future patterns. A retrospective cohort design included patients with at least one recorded medical visit during the study period. Incidence proportion (new cases per population), prevalence (total number of affected individuals), and incidence rate (cases per person-day) were calculated. Changes over time were assessed as percentage differences, and predictive modeling targeted high-risk racial groups. Overall incidence proportion declined (−16.6% in females, −18.9% in males). However, prevalence rose in Black (+31.6%), Hispanic (+41.7%), and White (+50.9%) populations, indicating sustained disease burden. Incidence rate increased in all racial groups, peaking in Native American (+63.9%) and Hispanic (+45.9%) individuals. Age analysis revealed slower declines in new cases among Black and Hispanic children (0–19) compared to adults (> 20), suggesting persistent pediatric risk. Predictive models indicate ongoing disparities, with a higher burden in Black and Hispanic populations through 2030. New cases of fish-related anaphylaxis are declining, but prevalence and reaction rates are rising, especially among children and high-risk racial groups. Targeted strategies, improved access to care, and long-term management are needed to reduce disparities. This study, limited by reliance on electronic health records and lack of environmental or genetic data, highlights the need for prospective multi-center research to guide interventions and reduce long-term disease burden. • New cases fell: −16.6 % in females, −18.9 % in males. • Prevalence rose in Black, Hispanic, and White groups. • Reaction rate highest in Native American and Hispanic groups. • Black and Hispanic children saw slower decline in new cases. • Disparities projected to persist through 2030.